Comorbidity Burden May Increase Disease Activity in MS Patients

A higher comorbidity burden in clinical trial participants with multiple sclerosis (MS) was associated with an increased hazard of MS disease activity, according to study results published  in JAMA Neurology.

“The adverse association of comorbidities with disease activity suggests that prevention and management of comorbidities in patients with MS should be a pressing clinical concern,” wrote corresponding author Amber Salter, PhD, of UT Southwestern Medical Center, Dallas, Texas, and study coauthors.

The study used a meta-analytic approach to investigate the association between comorbidities and disease activity in 16,794 participants with MS from 17 phase 3 clinical trials of disease-modifying therapies. Comorbidities in the analysis were present at trial enrollment and included hypertension; hyperlipidemia; functional cardiovascular disease, ischemic heart, cerebrovascular, and peripheral vascular disease; diabetes; autoimmune thyroid and miscellaneous autoimmune conditions; migraine; lung and skin conditions; depression; anxiety; and other psychiatric disorders.

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Over 2 years of follow-up, evidence of disease activity—defined as confirmed relapse activity, disability worsening, or any new lesions on magnetic resonance imaging—occurred in 61% of the pooled trials.

Compared with no comorbidity, 3 or more comorbidities was associated with an increased hazard for evidence of disease activity after adjustment for several factors. Researchers reported an adjusted hazard ratio of 1.14.

Meanwhile, the adjusted hazard ratio for evidence of disease activity with 2 or more cardiometabolic conditions, specifically, was 1.21 compared with no cardiometabolic conditions, the study found. A single psychiatric disorder had a 1.07 hazard ratio for evidence of disease activity compared with no psychiatric disorders. Depression, in particular, had a 1.11 hazard ratio for evidence of disease activity compared with no depression.

“Identification of optimal care models and teams for managing comorbidity in patients with MS is still needed,” researchers wrote, “as are clinical trials that establish whether treating comorbidity improves outcomes and whether or not management of comorbidity for people with MS should differ from that in the general population.”

Reference

Salter A, Lancia S, Kowalec K, Fitzgerald KC, Marrie RA. Comorbidity and disease activity in multiple sclerosis. JAMA Neurol. Published online September 18, 2024. doi:10.1001/jamaneurol.2024.2920